Left ventricular hypertrophy

2021-07-27 11:15 AM

Left ventricular hypertrophy develops in response to certain factors, such as high blood pressure, that require the left ventricle to work harder.

Define

Left ventricular hypertrophy is an enlargement of the muscle tissue that makes up the wall of the left ventricular chamber.

Left ventricular hypertrophy develops in response to certain factors, such as high blood pressure, that require the left ventricle to work harder. As the workload increases, the wall grows thicker, loses elasticity, and eventually may not pump with as much force as a healthy heart.

Left ventricular hypertrophy is more common in people with hypertension or other heart diseases.

Symptoms

Left ventricular hypertrophy usually develops gradually, with probably no signs or symptoms, especially in the early stages of this condition. As left ventricular hypertrophy progresses and complications develop, symptoms may include:

Shortness of breath.

Chest pain.

Feeling of fast heartbeat, fluttering, or palpitations.

Dizzy.

Fainting.

Rapid exhaustion with physical activity.

Call your local emergency number if you feel chest pain that lasts more than a few minutes or has severe shortness of breath. If you experience mild shortness of breath or other symptoms, such as palpitations, see your doctor.

If you have high blood pressure or another condition that increases your risk of left ventricular hypertrophy, talk to your doctor about regular appointments for heart monitoring. Even if you feel fine, you need to have your blood pressure checked every year, or more often if smoking, being overweight, or having other problems that increase your risk of high blood pressure.

Causes

Left ventricular hypertrophy can occur when one or more things make it work harder than usual for the heart to pump blood to body tissues. For example, if you have high blood pressure, the muscles of the left ventricle must contract harder than usual to effectively deal with high blood pressure.

Adaptation to high blood pressure can lead to larger left ventricular wall muscle tissue. The increase in muscle mass makes the heart work less efficiently.

Factors that can make the heart work harder include:

Hypertension. This condition is the most common cause of left ventricular hypertrophy. Blood pressure is given in a unit of measurement called millimeters of mercury (mm Hg). Hypertension is usually defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg, or 140/90 mm Hg. Systolic pressure is the blood pressure while the heart is contracting and diastolic pressure is the blood pressure while the heart is resting between beats.

Aortic valve stenosis. This disease is a narrowing of the aortic valve opening, the flap separating the left ventricle and aorta, the large blood vessel that supplies oxygen-rich blood to the body. This partially obstructs the flow of blood from the left ventricle, requiring it to work harder to pump blood into the aorta.

Hypertrophic cardiomyopathy. In this disease, the heart muscle becomes abnormally thick - or dilated (hypertrophied). Thickened heart muscle can make it harder for the heart to pump blood.

Athlete's heart. High intensity, endurance stretching, and strength training can cause adaptation to be able to handle the extra workload. In some people, these changes can lead to left ventricular hypertrophy.

Other medical conditions. Certain rare conditions, such as certain types of muscular dystrophy and Fabry disease, combined with changes in the heart increase the risk of left ventricular hypertrophy.

Risk factors

Risk factors for left ventricular hypertrophy include:

Hypertension, blood pressure greater than 140/90 mm Hg is the highest risk factor.

Aortic stenosis, narrowing of the orifice, can increase the workload of the left ventricle.

Obesity can cause high blood pressure and increase the body's need for oxygen, factors that can lead to left ventricular hypertrophy.

Complications

The muscles lose their elasticity and enlarge, preventing the heart's chambers from functioning properly and leading to increased pressure in the heart.

Hypertrophic muscle tissue compresses the coronary arteries and can restrict blood supply.

The muscles are overworked.

The heart is not able to pump enough blood to the body.

Abnormal heart rhythm (arrhythmia).

Insufficient oxygen supply to the heart (ischemic heart disease).

Interruption of blood supply to the heart (heart attack).

Apnea Sudden cardiac arrest, loss of function and consciousness (sudden cardiac arrest).

Tests and diagnostics

If there are signs and symptoms associated with heart disease - like shortness of breath, chest pain, palpitations, or other - your doctor will check your heart function and choose the best treatment.

If high blood pressure is present, your doctor may order heart-related testing as part of the ongoing management of the condition.

For some tests, your doctor may refer you to a heart specialist (cardiologist). Screening tests for left ventricular hypertrophy include:

ECG. Also called an ECG or EKG - records electrical signals as they travel through the heart. Your doctor can look for patterns in those signals that indicate abnormal heart function and increased left ventricular muscle tissue.

Echocardiography. An echocardiogram uses sound waves to create images of the heart. This test typically allows the doctor to see how the ventricles relax and the valves open and close during the heartbeat.

Echocardiography is a key tool for the diagnosis of left ventricular hypertrophy. If left ventricular hypertrophy is present, the doctor will be able to see a thickening of muscle tissue in the left ventricle. An echocardiogram can also reveal blood being pumped from the heart with each beat and movement of the heart wall. It can also show cardiovascular-related abnormalities, such as aortic stenosis.

Magnetic resonance imaging (MRI). Magnetic resonance imaging is a technique that uses a magnetic field and radio waves to create images of soft tissue in the body. It can be used to create cross-sections of the heart or 3D images.

Treatments and drugs

Treatment of left ventricular hypertrophy focuses on the underlying cause of the condition. Depending on the cause, treatment may involve medication or surgery.

Treatment of high blood pressure

Treatment for high blood pressure usually includes both medication and lifestyle changes, such as regular exercise; low sodium, a low-fat diet, and no smoking.

In addition to lowering blood pressure, certain antihypertensive drugs can prevent further enlargement of left ventricular muscle tissue and may even reduce muscle hypertrophy. High blood pressure medications that can reverse the development of hypertrophic cardiomyopathy include:

Thiazide diuretics. To help the body get rid of salt and water, thereby reducing blood volume. Thiazide diuretics are often the first - but not the only - of choice in high blood pressure medications.

ACE inhibitors. The drug dilates blood vessels, lowers blood pressure, improves blood circulation, and reduces the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril), and capxopril (Capoten).

ACE inhibitors cause coughing in some people. It may be best when not coughing, to get the benefit of the medicine. Discuss this side effect with your doctor. Switching to another ACE inhibitor or blocking angiotensin II may be the choice.

Block Angiotensin II (ARB). These include losartan (COZAAR) and valsartan (Diovan), which have many of the beneficial effects of ACE inhibitors, but they do not cause a persistent cough. Maybe an alternative for people who cannot tolerate ACE inhibitors.

Beta-blockers. It slows heart rate lowers blood pressure and prevents some of the harmful effects of stress hormones. These include atenolol (TERNOMIN), carvedilol (Coreg), metoprolol (Toprol XL), and bisoprolol (Zebeta).

Calcium channel blockers. Prevents calcium from entering heart cells and blood vessel walls. This lowers blood pressure. These drugs include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR), nifedipine (Procardia), and verapamil (Calan, Verelan, Covera-HS).

Repair or replace the aortic valve

If left ventricular hypertrophy is due to aortic stenosis, surgery may be required to remove the stenosis and replace it with an artificial valve, a biological tissue valve from bovine, porcine, or cadaveric donors. If there is aortic regurgitation, the leaky valve can be surgically repaired or replaced.

Prevention

The best way to help prevent left ventricular hypertrophy is to maintain healthy blood pressure. Here are a few tips for better blood pressure management:

Monitor blood pressure. If you have high blood pressure, measure and check your blood pressure regularly. Schedule regular checkups with your doctor. A healthy blood pressure goal is less than 120/80 mm Hg.

Make time to exercise. Regular exercise helps lower blood pressure. Aim for 30 minutes of moderate activity each day at least five days a week. Talk to your doctor about the need to limit certain physical activities, such as weightlifting, which can temporarily raise blood pressure.

Monitor your diet. Avoid foods that are high in fat and salt, and eat plenty of fruits and vegetables. Avoid alcohol and caffeinated beverages, or drink them in moderation.